Provider Demographics
NPI:1194936781
Name:FOWLER, JENNIFER EMSWILER (MPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:EMSWILER
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:EMSWILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:50151 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6712
Mailing Address - Country:US
Mailing Address - Phone:734-844-6774
Mailing Address - Fax:
Practice Address - Street 1:729 W ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1631
Practice Address - Country:US
Practice Address - Phone:734-414-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012210225100000X
NC8330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist